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How Technology Can Improve Medication Management During Transitions of Care

An electronic personal health record (ePHR) is at the heart of a medication management program in Rhode Island that aims to help recently discharged hospital patients avoid a return to the hospital.

Researchers from the University of Rhode Island College of Pharmacy implemented the program in 2011 in partnership with Healthcentric Advisors, the state’s Medicare Quality Improvement Organization (QIO); the state’s Division of Elderly Affairs; and local hospitals.

Pharmacist Visit and ePHR Tutorial

The Rhode Island Care Transitions Program targeted state residents with diabetes, respiratory illness, cardiovascular disease or related conditions. Patients joined the program at the invitation of the QIO or nurse case managers working within the state's Medicaid program. Some participants were recruited while receiving care at the local community hospital.

A pharmacist implemented the program by:

Conducting home visits. The pharmacist met with each participant after hospital discharge to review the patient’s medications and discuss medication-related problems. If necessary, the pharmacist encouraged the patient to contact the prescribing physician or the pharmacy.

Demonstrating the ePHR. The pharmacist encouraged each patient to use a free ePHR provided by ER-Card, LLC of West Warwick, RI. If the patient agreed, the pharmacist helped the patient input his or her health information. The pharmacist also explained how the patient could use the ePHR to manage his or her health conditions and share health information with health providers.

Recruiting patients. The pharmacist also scheduled home visits and responded to follow-up questions patients had about their medications and the ePHR system.

68 Participants, 30 Home Visits and 20 ePHRs

According to a report about the intervention published by the Center for Aging and Technology in Oakland, CA:

300 hospitalized or recently discharged patients were invited to participate in the program.

68 patients agreed to participate.

30 patients completed the pharmacist home visit.

20 patients agreed to use the ePHR. Seven of these patients reported using the ePHR to share information with care providers during post-discharge encounters.

19 patients had a medication-related problem that the pharmacist addressed.

3 patients (16%) were re-hospitalized within 30 days. Researchers note that re-hospitalization data was unavailable for 11 patients. In comparison, 2001 readmission rates for the state’s broader care transitions initiative were 11.8% for coached patients and 23.5% for patients who did not fully participate in the intervention.

Tips for Adopting a ePHR Intervention

Researchers identified several lessons they learned from the pharmacist-directed care transition program:

Recruit healthy patients. Patients seemed reluctant to join the program either during or immediately following a hospital stay. As an alternative, it might be easier to recruit patients who are at high risk for hospitalization but have not yet been hospitalized. For best results, set up ePHRs when these patients are in relatively stable health.

Get physicians involved. Patients might be more willing to participate in a medication management initiative if their doctors recommend it.

Address issues around home visits. Patients were generally reluctant to take part in home visits. In addition, many patients did not think a medication review was important. Finally, the program’s pharmacist had concerns about the safety of some neighborhoods.

Find ways to cut costs. Programs can save money by finding someone other than the pharmacist to recruit patients and schedule home visits.